INFANTS ANDPRE-SCHOOL CHILDREN

For the first few months of a baby’s life, breastmilk or infant formula, together with the store of nutrients they are born with, provide all the nourishment they need. But there comes a time, at around 6 months, when babies need additional sources of nutrients to help them grow and develop. This is the time to slowly start introducing complementary foods to their diet alongside breastmilk or formula.

Complementary foods can be gradually introduced to your baby’s diet alongside breastmilk or infant formula at around 6 months of age. Some babies may be ready before this but if you do give your baby solids before 6 months, there are some foods that should be avoided because they are sometimes linked to allergy. Babies born prematurely may be ready for solids a little later than 6 months. Ask your health visitor for advice about what’s best for your baby.

Start slowly; during a milk feed, offer:

Baby cereal mixed with breastmilk or infant formula

Soft or cooked (allow to cool before eating) fruit or vegetables, mashed or as finger food such as carrot, potato, sweet potato, yam, parsnip, apple or pear, banana, mango, melon or avocado

Swordfish, marlin and shark – these contain mercury which can affect a growing nervous system

Cow’s milk shouldn’t be given as a main drink until your baby is one year old.

It’s best to let your baby lead you, there a few signs that will tell you when they are ready for solid foods:

They are able to stay in a sitting position and hold their head steady

They have begun to develop hand-eye coordination, so that they can coordinate lifting the food and putting it in their mouth without assistance

They can swallow food and not push it back out again

They seem to be less satisfied with just their milk feeds

They are interested when others are eating

A few important things to remember when you start introducing solid foods:

Never leave your baby alone when eating

Make sure they are well supported in a sitting position, preferably in a high-chair and start feeding slowly

Go at your baby’s pace

Never leave your baby alone with a bottle or give a bottle to help with sleep as it could cause choking as well as damaging teeth

Never add food to a bottle

Don’t leave meals until your baby is too hungry or tired to eat

It’s very common for young children to go through phases of being fussy about what they eat. Sometimes eating very little, wanting to eat the same thing every day or refusing to eat certain foods, even ones they liked before!

It’s important not to get too worried – remember this is completely normal, and rarely harmful.

TIPS ON HOW TO COPE

Try to keep calm! It’s important not to turn mealtimes into a battleground

Eat your meals together, the best way for your child to learn to eat and enjoy new foods is to copy you and other family members

Keep portions small at first and praise your child for eating them

If after gentle encouragement, your child refuses to eat something, just remove it without making a fuss

Don’t leave meals until your child is too hungry or tired to eat

Don’t give too many snacks between meals. Limit them to a milk drink and some fruit slices or a small cracker with a slice of cheese, for example

Try not to use food as a reward; it can lead to an acceptance of sweet foods as ‘good’ and vegetables as ‘bad’. Instead you could use a reward chart which could lead to a big trip out or activity once they collect enough stickers to fill their chart

Eggs (when introduced, eggs should be thoroughly cooked until the white and yolk are solid)

Cow’s milk*** and dairy products such as yogurt and cheese

IMPORTANT TO REMEMBER

Foods containing these ingredients may also be linked to allergy.

* Whole nuts should not be given to children under 5 years.

** If your child is at high risk of peanut allergy (has already been diagnosed with or there is a family history of any allergy) you should speak to your healthcare professional before you give peanuts or foods containing peanuts for the first time.

*** Milk and milk alternatives, other than breastmilk or infant formula, should not be given as a drink until one year. Soya-based infant formula and soya products should only be used if advised by your healthcare professional, as babies who are allergic to cow’s milk may also be allergic to soya.

The food children are given at break and lunchtime at nursery school can make an important contribution to their dietary intake and teach them good habits around food. Food served in early years settings has vastly improved in recent years, with many nurseries following government guidelines for nutrition and food quality.

Countries within Great Britain are governed by school food policies that are specific to England, Scotland or Wales.

ENGLAND

The School Food Standards set out the requirements for food provided in educational settings in England. They are designed to ensure pupils are offered nutritious meals and snacks during the school day and aim to increase the vitamin and mineral content and decrease fat, saturated fat, sugar and salt content from children’s diets.

SCOTLAND

Better Eating, Better Learning was released in 2014 to help schools, local authorities, caterers, parents in Scotland, to work together to make further improvements in school food and food education. It is aimed at those in primary and secondary education but is useful for early years settings too.

The under-fives need small, nutritious meals with nourishing snacks in between. The best way to make sure they get all the nutrients and energy they need is to give them a wide variety of nutrient rich foods; ones that provide lots of vitamins and minerals, from the four main food groups. And remember, snacks as well as meals count towards a healthy balanced diet.

MILK AND DAIRY FOODS

Dairy products provide important nutrients for people of all ages, but are particularly important for small children. Milk, hard cheese and yogurt are the main providers of bone-building calcium in the UK diet (see Calcium) and are also rich in protein, which is important for children’s growing bones.

You should aim to give children about three servings of dairy each day, either as a milk drink or in the form of milk-based dishes, hard cheese or yogurt. As well as calcium and protein, milk is packed with vitamins B2, B12 and iodine, and contains phosphorus and potassium too. If your child doesn’t like to drink milk, try to make sure you offer a selection of other dairy foods such as hard cheese and yogurt.

Examples: milk, hard cheese, yogurt.

WHICH MILK?

Between the ages of one and two, it is recommended that toddlers have whole milk to drink rather than skimmed or semi-skimmed milk. Compared with lower-fat milks, whole milk provides extra energy and fat, which are important for growing children. From two years old, you can start to introduce semi-skimmed milk if your child is eating a good variety of foods and growing well, otherwise stick to whole milk. Skimmed milk and 1% fat milk aren’t suitable as main drinks for children under five.

TIPS

Milk can also be used in custard, milk puddings, soups and sauces

A cheesy sauce on pasta or as cauliflower cheese ups dairy intake too

Try giving yogurt or fromage frais as a tasty pudding or snack

THE NURSERY MILK SCHEME

The Nursery Milk Scheme enables children under five to receive 189ml (1/3 pint) of milk, free of charge, on each day they attend approved day-care facilities for two hours or more. This includes children in pre-schools, nurseries, playgroups, and primary school nursery classes. To find out more visit www.nurserymilk.co.uk.

MILK ALLERGY

An allergy to cow’s milk is estimated to affect around 1 in 50 infants. Most children will have outgrown the problem by the time they start school.

If you think your child is allergic to milk, you should consult your GP. If a milk allergy is diagnosed, the doctor will refer you to a registered dietitian for specialist dietary advice.

Neither goat’s nor sheep’s milk are a suitable replacement for cow’s milk; your child’s body will react in the same way as it does to cowss milk. Soya products should only be used if advised by a GP or dietitian, as children who are allergic to cow’s milk may also be allergic to soya.

BREAD, RICE, POTATOES, PASTA AND OTHER STARCHY FOODS

These starchy foods provide energy, vitamins, minerals and fibre. Try to give kids at least one serving from this group with each meal and some as snacks too. For kids, it is important to offer a mixture of white, brown and wholegrain varieties. It’s not a good idea to give only wholegrain starchy foods, because they can be too filling for small children, meaning your child could become full before they have taken in enough calories.

FRUIT AND VEGETABLES

Fruits and vegetables are full of vitamins and minerals that are great for growing children. Aim for five suitably-sized portions each day, remembering that a toddler’s serving size will be smaller than an adult’s. As a rough guide, one portion is about the amount they can fit in the palm of their hand. As a child grows, portion sizes can be increased accordingly.

Offer as many different varieties as possible; the more colours the better! And remember that frozen and tinned versions provide just as many nutrients and are quick and easy to prepare.

Potatoes are a ‘starchy’ food and so don’t count towards the 5-a-day target.

TIPS

Making a smoothie with fruit and yogurt or milk is a good way to get your child to eat more fruit, and at the same time, providing them with a portion of dairy.

To increase your child’s vegetable intake while hiding the taste, blend vegetables into soups and stews.

Serving different colours of fruits and vegetables together will make them more appealing to young children. Or try arranging fruits or vegetables in smiley faces.

Try cutting fruit and vegetables into small pieces and offering these as finger foods with a dip. For example, serve carrot sticks with a dip such as houmous, or fruit slices with a yogurt dip.

MEAT, FISH, EGGS, BEANS AND OTHER NON-DAIRY SOURCES OF PROTEIN

Foods in this group provide protein and iron for growing bodies. For more information on the benefits of iron, see Other nutrients. Try to give two servings of foods from this group each day to toddlers eating meat and fish or two or three servings of a variety of alternative protein sources each day to vegetarian toddlers.

ADVICE ON OILY FISH

Oily fish such as mackerel, salmon, and sardines are good sources of omega-3 fatty acids; two portions per week is adequate to meet your child’s needs.

ADVICE ON WHOLE NUTS

Children under five years old shouldn’t be offered whole nuts because of the risk of choking.

ADVICE ON PEANUTS

As long as there is no history of food or other allergies in your family, you can give your toddler peanuts. Make sure they are crushed or ground into peanut butter. If your child already has a known allergy or there is a history of allergy in your child’s immediate family (either parent or sibling) you should speak to your healthcare professional before you give peanuts or foods containing peanuts for the first time.

FOODS AND DRINKS CONTAINING FAT AND/OR SUGAR

These foods provide calories, but few nutrients so should only be given occasionally and in small amounts. They should not be used to replace nutritious foods from the other food groups.

DRINKS

By this age, children should be using an open cup or free-flow cup (with no valve) for their drinks; still using a bottle can slow speech development and damage their teeth.

Milk and water are the best drinks for young children. Milk is packed with important nutrients including calcium, protein, potassium and a number of B vitamins, both milk and water are suitable drinks for between meals.

New guidelines recommend reducing sugar intake by decreasing the frequency of sugar-sweetened beverages and fruit juices in the diet. If you choose to give your child fruit juice it should always be well diluted and given in a cup not a bottle and at mealtimes.

Squashes and other soft drinks aren’t suitable for toddlers, even the ‘diet versions’. Not only are they bad news for teeth, their nutrient content is low too. Toddlers who drink them frequently can have less room to eat well at mealtimes. If you do give these drinks to your child, make sure they’re well diluted in a cup at mealtimes. Fizzy drinks should not be given at all.

It’s also best not to give children under five tea or coffee, as these can interfere with the body’s absorption of iron – see our Other nutrients section.

IDEAS FOR HEALTHY SNACKS

Fresh fruit

Vegetable sticks with a dip such as houmous

Small cheese cubes with fruit

Yogurt or fromage frais

Small sandwiches (filled with grated cheese, egg, tuna or lean meat)

Rice cakes, bread sticks or oat cakes

Toasted muffin or bagel

Small bowl of breakfast cereal and milk

Scones, crumpets or pancakes

HEALTHY START

To help give children a good nutritional start in life, the government runs the Healthy Start Scheme. It allows pregnant women and parents, with young children, on low incomes to exchange vouchers for free milk, fruit and vegetables.

The vouchers can be used in shops taking part in Healthy Start, and also with local milk men. To find out more about Healthy Start ask your health visitor, or visit www.healthystart.nhs.uk